BILL NUMBER: AB 1196 AMENDED
BILL TEXT
AMENDED IN ASSEMBLY APRIL 10, 2003
AMENDED IN ASSEMBLY APRIL 3, 2003
INTRODUCED BY Assembly Member Montanez
FEBRUARY 21, 2003
An act to amend Section 2836.1 of the Business and Professions
Code, relating to nurse practitioners.
LEGISLATIVE COUNSEL'S DIGEST
AB 1196, as amended, Montanez. Nurse practitioners:
prescriptions.
Existing law, the Nursing Practice Act, licenses and regulates
nurse practitioners and authorizes a nurse practitioner to furnish
drugs or devices that are classified as Schedule III to Schedule V
controlled substances under the California Uniform Controlled
Substance Substances Act, subject to
certain conditions. Existing law makes a violation of the act a
misdemeanor.
This bill would expand these provisions to include drugs or
devices that are classified as Schedule II controlled substances
under the California Uniform Controlled Substances Act. The bill
would establish additional requirements for a nurse practitioner who
is authorized to furnish drugs or devices, including registering with
the United States Drug Enforcement Administration. The bill would
require the Board of Registered Nursing to certify and issue a nurse
practitioner a number that the nurse practitioner must document on
all prescriptions he or she transmits. The bill would require nurse
practitioners to complete a continuing education course on
including Schedule II controlled substances
based on standards developed by the board.
By increasing the scope of the Nursing Practice Act, the violation
of which is a misdemeanor, this bill would impose a state-mandated
local program.
The California Constitution requires the state to reimburse local
agencies and school districts for certain costs mandated by the
state. Statutory provisions establish procedures for making that
reimbursement.
This bill would provide that no reimbursement is required by this
act for a specified reason.
Vote: majority. Appropriation: no. Fiscal committee: yes.
State-mandated local program: yes.
THE PEOPLE OF THE STATE OF CALIFORNIA DO ENACT AS FOLLOWS:
SECTION 1. Section 2836.1 of the Business and Professions Code is
amended to read:
2836.1. Neither this chapter nor any other provision of law shall
be construed to prohibit a nurse practitioner from furnishing or
ordering drugs or devices when all of the following apply:
(a) The drugs or devices are furnished or ordered by a nurse
practitioner in accordance with standardized procedures or protocols
developed by the nurse practitioner and his or her supervising
physician and surgeon under any of the following circumstances:
(1) When furnished or ordered incidental to the provision of
family planning services.
(2) When furnished or ordered incidental to the provision of
routine health care or prenatal care.
(3) When rendered to essentially healthy persons.
(b) The nurse practitioner is functioning pursuant to standardized
procedure, as defined by Section 2725, or protocol. The
standardized procedure or protocol shall be developed and approved by
the supervising physician and surgeon, the nurse practitioner, and
the facility administrator or his or her designee.
(c) The standardized procedure or protocol covering the furnishing
of drugs or devices shall specify which nurse practitioners may
furnish or order drugs or devices, which drugs or devices may be
furnished or ordered, under what circumstances, the extent of
physician and surgeon supervision, the method of periodic review of
the nurse practitioner's competence, including peer review, and
review of the provisions of the standardized procedure.
(d) The furnishing or ordering of drugs or devices by a nurse
practitioner occurs under physician and surgeon supervision.
Physician and surgeon supervision shall not be construed to require
the physical presence of the physician, but does include (1)
collaboration on the development of the standardized procedure, (2)
approval of the standardized procedure, and (3) availability by
telephonic contact at the time of patient examination by the nurse
practitioner.
(e) For purposes of this section, no physician and surgeon shall
supervise more than four nurse practitioners at one time.
(f) (1) Drugs or devices furnished or ordered by a nurse
practitioner may include Schedule II through Schedule V controlled
substances under the California Uniform Controlled Substances Act
(Division 10 (commencing with Section 11000) of the Health and Safety
Code) and shall be further limited to those drugs agreed upon by the
nurse practitioner and physician and surgeon and specified in the
standardized procedure.
(2) When Schedule II or III controlled substances, as defined in
Sections 11055 and 11056, respectively, of the Health and Safety
Code, are furnished or ordered by a nurse practitioner, the
controlled substances shall be furnished or ordered in accordance
with a patient-specific protocol approved by the treating or
supervising physician. A copy of the section of the nurse
practitioner's standardized procedure relating to controlled
substances shall be provided upon request, to any licensed pharmacist
who dispenses drugs or devices, when there is uncertainty about the
nurse practitioner furnishing the order. For Schedule II controlled
substance protocols, the provision for furnishing Schedule II
controlled substances shall address the diagnosis of the illness,
injury, or condition for which the Schedule II controlled substance
is to be furnished.
(g) (1) The furnishing or ordering of drugs or devices by a nurse
practitioner is conditional on the board issuing the nurse
practitioner a number after he or she has successfully completed the
requirements of paragraph (2). The nurse practitioner shall include
that number on all his or her transmittals of orders for drugs or
devices. The board shall maintain a list of the nurse practitioners
it has certified pursuant to this section and the number it has
issued to each nurse practitioner. The board shall make the list
available to the California State Board of Pharmacy upon its request.
A nurse practitioner who is authorized to furnish or issue a drug
order for a controlled substance shall register with the United
States Drug Enforcement Administration.
(2) The board has certified in accordance with Section 2836.3 that
the nurse practitioner has satisfactorily completed (1) at least six
month's physician and surgeon-supervised experience in the
furnishing or ordering of drugs or devices and (2) a course in
pharmacology covering the drugs or devices to be furnished or ordered
under this section.
(3) Nurse practitioners who are certified by the board and hold an
active furnishing number, who are authorized through standardized
procedures or protocols to furnish Schedule II controlled substances,
and who are registered with the United States Drug Enforcement
Administration, shall complete, as part of their continuing education
requirements, a course on including
Schedule II controlled substances based on the standards developed by
the board. The board shall establish the requirements for
satisfactory completion of this subdivision.
(h) Use of the term "furnishing" in this section, in health
facilities defined in subdivisions (b), (c), (d), (e), and (i) of
Section 1250 of the Health and Safety Code, shall include (1) the
ordering of a drug or device in accordance with the standardized
procedure and (2) transmitting an order of a supervising physician
and surgeon.
(i) "Drug order" or "order" for purposes of this section means an
order for medication which is dispensed to or for an ultimate user,
issued by a nurse practitioner as an individual practitioner, within
the meaning of Section 1306.02 of Title 21 of the Code of Federal
Regulations. Notwithstanding any other provision of law, (1) a drug
order issued pursuant to this section shall be treated in the same
manner as a prescription of the supervising physician; (2) all
references to "prescription" in this code and the Health and Safety
Code shall include drug orders issued by nurse practitioners; and (3)
the signature of a nurse practitioner on a drug order issued in
accordance with this section shall be deemed to be the signature of a
prescriber for purposes of this code and the Health and Safety Code.
SEC. 2. No reimbursement is required by this act pursuant to
Section 6 of Article XIII B of the California Constitution because
the only costs that may be incurred by a local agency or school
district will be incurred because this act creates a new crime or
infraction, eliminates a crime or infraction, or changes the penalty
for a crime or infraction, within the meaning of Section 17556 of the
Government Code, or changes the definition of a crime within the
meaning of Section 6 of Article XIII B of the California
Constitution.